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Tuesday, August 17, 2010

Remembering August 20, 2009

This post was originally going to appear later this week on Aug. 20, but that's Friday when I like to keep the posts on the lighter side. So, I was going to go with the day before, but then this whole "Driving With Diabetes" topic came up as one that might be included in the weekly Wednesday night Diabetes Social Media Advocacy (#dsma) discussions. So, I opted for today. To write about how my life changed on Aug. 20, 2009.

That was the day a chain came out of nowhere, wrapped around my neck, and started squeezing. Ever since, the chain continues adding more links and squeezing around my neck to the point where I can't breathe.

But for all the scariness that happened that day and since then, I owe a lot to what happened. It changed my life, in terms of my thinking about God, CGMs, real-life policy issues, financial obligations, and the overall health care and insurance system. The past year has been a time of personal reflection, a spiritual journey, as well as real change in how I deal with my Type 1 diabetes - all as a direct result of what happened that day.

Everything began that afternoon at work. A newspaper reporter, I had an interview at 3 p.m. Wrote on the board that I was leaving the office for said interview. Problem: it was a phone interview, but my mind couldn't remember that important detail. Thanks to a Low. One that I didn't see coming, as I'd just recently done a test that was above 100 mg/dL, had eaten a decent lunch, and done everything else as correctly as I could. Yet somehow, my blood sugar dropped.

I recall missing my black lab Riley, and just wanting to see her. That I needed to get home to see her. Maybe, right after my interview. Wrote on the board. Packed up my belongings, and left the office. Walked to the parking garage and got behind the wheel. Why no BG test? I'd just done one, and as mentioned, it was fine - above 100. No need. But I was already Low, and was still plummeting. Actually, I made it through most of the 10-mile drive home. But probably because my sugar was low, I missed my freeway exit and had to drive another five miles south before circling back. Instead of getting back onto the freeway, I took the back roads. Ended up getting lost on the farm roads that I normally know very well, but just couldn't make sense of in this Low BG state. Eventually made it back to my subdivision, but ended up driving back and forth and around the area, with reports that I drifted in and out of oncoming lanes of traffic. Cloudy memories of driving up on a grassy side median still haunt me. Some called 9/11. I ended up in a ditch just across my subdivision entrance, with a police officer approaching my window. I rolled it down. As this happened, I recall thinking that I had to "escape." Words came at me, but I was fumbling with my key in the ignition (the SUV was still running) and trying to put the vehicle into reverse to drive away. The officer leaned into my window and quickly grabbed the keys from the ignition, then opened the door and pulled me out. That's about all I remember, before waking up in the back of an ambulance at the scene and having glucose pumped into my system. Then, being transported to the local ER despite my repeated attempts from the back-of-the-ambulance stretcher restraints to decline that transportation.

As it turned out, my parents were visiting from Michigan that day - so in my Low mindset while driving I not only phoned my wife's cell (she was working), but I also phoned my dad's cell. So the paramedics grabbed my phone in the confusion of moving me and dialed the last number I'd called, therein alerting my parents to the situation and having them meet at the nearby hospital. It was an all around good time, indeed.

For the record: I do carry an array of glucose tablets in my vehicle as well as Skittles and some crackers. As indicated above, I also test before driving. But sometimes that's not enough, and doesn't prevent these situations from happening. Not in the same way a CGM might, in alerting the D-Driver to a dropping BG while on the road or even before they get behind the wheel after a "safe" test reading.

This was probably one of the most scariest examples of my life. In the weeks after this happened, I'd be hesitant to drive anywhere and would be even more fervent about my testing before putting the key into the ignition. I wondered countless times whether I should be driving at all, whether it's in the best interest of society for a Type 1 diabetic to be behind the wheel. I'd also reflect on the bigger meaning of all this, praying thankfully that He protected everyone else on the road and somehow saw fit to protect me. This was one of two "near-death or likely-death" examples that happened to me in the course of a month, and to me showed that He was a real force in my life looking out for me.

But there's more to this story.

Within a week of this incident, the bills started arriving demanding payment. Even before my insurance company was able to receive, review, and process my coverage for these claims from the various providers: ambulance, ER, the ER doc, and multiple others who apparently were a part of this process.

The 4-mile ambulance ride came out to more than $768 before insurance, which included $97 in mileage for the four miles - roughly $24 per mile. However, the ambulance company somehow calculated this to be $10 a mile with nine miles, even though that's more than double the distance from my subdivision entrance to where I ended up (wonder what route they took???) Anyhow, the first bill from them came within a week, before insurance could even respond. A month or so later, it was clear I was only going to be responsible for $367.

The ER bill came out to $2,797 for less than two hour visit that was largely just wait-time. Insurance picked up most of that, minus a co-pay and whatever applied to my deductible - meaning I got hit with a $468 tab.

Then you have the various doctors who popped their heads in or looked at one piece of paper, such as the unneeded EKG, and it came out to about an extra $100 on my end.

For a grand total: $933. About 25% of the total pre-insurance tab for that day.

For all its faults and headaches, insurance coverage is a savior when analyzing the total payout and cost benefit. You truly have to appreciate that. Still, I just wasn't planning for that additional $933 expense, in addition to the $454 post-insurance amount for lab tests that I'd had done just a week before.

These expenses are monumental, particularly when combined with the mortgage payment and all the other debts and living expenses we have. I'm simply unable to pay them all, though I'm trying to do as much as possible while juggling every other debt and expense in my life. Some are willing to work, others aren't as receptive to the idea. That's an ongoing battle.

What that amount does is make you reflect more intensely on what you could have done, if anything, to prevent this from happening. Had I had a CGM, this may not have happened. I'd done everything possible without one, and it still came to be. But had there been a device tracking my BG level and examining the direction I was going, maybe the alarm would have alerted me to this and caused me to look differently at the 100+ mg/dL snapshot that had been offered just before this all began happening.

So, that is the lesson from all this. I've found my faith and started truly establishing my relationship with Jesus and God. Saw the true real need for a CGM. Lived the dilemmas of Driving While Diabetic and what that means. And came to understand how quickly a "medical emergency" can hit your life, your pocketbook, and have long-lasting continuing impacts every day since.

I regret that this happened. But I continue trying my best to cope, to keep living, to learn, and advocate to those who could be in the same situation some day.

17 comments:

I think that is the most frustrating thing about diabetes. you can do everything right and still it bites you in the butt.

I'm glad you were ok. I'm glad that you got the help you needed right away. That is a blessing for sure.

I remember the bills rolling in for my husbands cancer last year. The insurance liked to deny claims because they weren't billed right. The clincher was the $32,000 dollar bill I got from the hospital saying our insurance denied the claim. Good times.

I think we all go through lessons in life that turn out to be huge, if we let them be. I am glad you are well, you are safe and that you changed some things in your life so that it has less of a chance of happening again. Blessings, Michael.

Thank you for sharing this story. Being new to Diabetes, and still learning so much, I think it was important to read this and understand just how much of an impact this can and will have on my life. Unfortunately, my endo and my educators haven't really informed me about a CGM at all, so I guess that will defintely be my biggest question at my next appointment. Thanks again, and so glad to hear you were able to find a positive in a very scary situation.

Oh Michael. I hate to hear stories like this, as I have one myself. Long story short, it was a hit-and run, but thankfully no one was injured. It spurred me to get on the pump after 21 years of injections. Experiences like that are scary, but know that by sharing it you are helping someone else prevent having the same thing happen.

I don't test before driving. My diabetes educator told me that I needed to, but it's difficult to "waste" a strip when I FEEL okay. Your story is making me re-think that.

I hate that our well-being is so tightly connected to money. Why shouldn't I be able to test once right before driving without worrying about the wasted dollar? Why shouldn't you be able to not stress about ambulance bills so you could focus on taking care of the day-to-day.

Wow. That's just scary. But glad you're okay. Stuff like this is still a long way off for My Bean, and it saddens me that diabetes may complicate her life even more as she gets older. But this is a reminder we all need.

It's ironic that you left a comment on my blog as I was sitting here thinking after reading your blog about driving with D. I was remembering about my severe low this year that rendered me unaware, but conscious. I had just finished playing in the two feet of snow with my two young children and had done all of then right things...even was on a CGM, but my sensor had just expired a couple of hours earlier and I put a new one on in the mornings...so I was in between. We have estimated I was out of it for at least an hour and a half before my husband found me. What was devastating to me is my children were essentially alone (4 & 9yrs). The guilt I still have is what has motivated me to stay on top of this. At times I feel I am obsessed. Your blog was really helpful in that it will serve to keep me ever mindful of driving with D. I check every time I drive, but sometimes you hate it and this is a reminder to endure it. Keep strong.

I'm glad you are o.k. and no one was hurt. Car accidents are scary enough with out adding low blood sugars into the mess I had a pretty bad accident 2 years ago, luckily not caused by diabetes, but an 18 yr old who didn't know a red light meant stop and he shouldn't have been speeding during a tropical storm.lol.I can still relate to your story. I worry often about the possibility of going low behind the wheel.Luckily I'm still sensitive to my lows and can usually feel them when I hit 80. However the other day I went to the local park by myself to walk. I checked as soon as I parked my car to make sure in the hour since I had left my house, and stopped at the pharmacy that my BG hadn't lowered too greatly. I was at 135. I lowered my basal rate since I decided I was going to try and do 2 laps around the lake( 1 lap is a mile). I put some hard candies in my meter bag, and my diabetic emergency card in my meter as well. I managed to get about a quarter of the way around when I felt light headed and decide I should check.Suddenly I was at 73. I ate some of the candies I had and waited 15 minutes .I had risen to 89.I figured I should try to walk back to my car where I had a bottle of Gatorade my boyfriend left in the car the night before.I knew it was old ,but would raise my BG better so that I could go to the gas station not even a mile up the road to get some better acting carbs in me. I managed to get back to my car ( I went back down to 70) Drank some Gatorade and finally managed to get to the gas station, but I worried the entire time I may drop and possibly pass out. I also worried about this because I am uninsured and can not afford to add to the 5000 dollars of medical debt I have already accumulated. It is scary to know you've done everything you should and to still have emergencies. I hope to get a CGM when I finally do get back on my mom's insurance in October(thanks to medical reform) so that I can try and avoid these kind of situations in the future.I was kinda scared at the time too, because it's been years since I've had a low incident with out someone being nearby. Any way it was a great blog.

The scariest thing about this article is how common this situation is and how often these lows can still happen. I do a blood sugar when ever I drive as well and I still ended up in much the same situation as you. I had tested low and eaten but of course ate more than I needed so I had to also give myself insulin. Thus I went low again because the food didn't have enough time to really get into my system. Now I do a square wave instead of a regular bolus. The other thing to point out is that if you are caught in an accident or pulled over by police while low you can also lose you drives licence and it is a real pain to get it back. Glad to hear all of these people where "ok" but it's really something to seriously consider. Cheers! Lisa

Wow see this is why I fear getting behind the wheel. I get alot of lows and not my fault I check 5-6 times a day and eat my meals on time. The idea of me causing an accident that might kill someone I can't I won't put anyone in harms way. So I get around by NJ transit.

Just wanted to say that i have been diabetic for 39 years diagnosed at 15 months old so really don't know any different, it is all about the positiveness that you have toward diabetes that makes it a much more positive outlook, i just recently went on the cgm and love it, but i also did very well with just the pump, yes had more lows but was still able to manage and maintain life. I have 2 children aged 12 and 10 and never went to any special hospital to have them, had them at our local general hospital and that was before a pump. I drive constantly, just wanted to put a positive outlook out there for people. Diabetes is what you make of it, 39 years with mine and have very minor complications.

OMG - I've been trying to write a blog at Diabetes1.org about a driving experience that was similar to yours - but quite as expensive - though it could have turned out similar to your experience. I just scared the #@!$ out of myself with what I had done - and like you - it took me almost a month to feel get behind the wheel again and not panic. It was my first experience like this in all the years of being diabetic behind the wheel - and if it happens again - I will give up my license - as I don't want to freak out people and myself again. Actually I have since resolved the issue of why it happened - as it was all very foggy as you can attest to I'm sure).Drive safe my friend!

I have 35 years with T1 and limited experience with a CGM; I'm in the process of trying a loaner for two weeks. But based on my experience, you shouldn't be so sure that a CGM would have helped.

I've had a few lows in these two weeks - the lowest 35 on my meter and another 38 on my meter. And in neither case did I get an alarm from my CGM - even after I had treated the low and was back in the normal range! The problem is that a CGM is registering your interstitial fluid, and not your blood. And interstitial fluid glucose reading are about 20 minutes behind your real BG. So if your BG is dropping quickly (i.e. after an injection that you didn't eat enough for) then you may get very low without any indication from your CGM. In my opinion, the CGM is much more useful for tracking highs than lows. And it does seem to be useful for overnight lows, which tend to come on more slowly.

Please remember that very expensive CGMS still has a 20 minute delay because you're not testing blood, you're testing interstitial fluid. On top of that, since you're calibrating to an up to 20% inaccurate glucose meter, the CGMS is likely to be even more inaccurate than the meter. Try to test it (the meter and CGMS) to a real lab blood draw a few times to see how off your CGMS might be under different conditions. By this I mean a % off in the 70 range may be an entirely different % off in the 200 range.

I test 12-15 times a day. The meter is by my side and I have no qualms about using it while driving (say while stopped at a stop light, stopped in traffic, etc.) - all 5 seconds. Honestly, we can never test too much.

To Doris and the other Anonymous Poster (if a different person): Thank you both for your thoughts and perspectives on this. For the record, I don't pretend to be able to guarantee any CGM might have prevented this. Nor do I have any confidence in the accuracy for general purposes. However, this isn't a matter of not testing prior to or during driving. This was an example of being fine, and then dropping to the point of having a Low before getting behind the wheel. In that situation, a CGM may have alerted me to the drop that could have been addressed and prevented me from being Low behind the wheel. Or even realizing that I didn't need to be driving in the first place. That's the point. Even with its early generation accuracy issues, a CGM is the best option we have currently to watch trends and patterns, rather than just snapshots with a fingerstick.

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Mike Hoskins

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